Provider Demographics
NPI:1720366636
Name:TAGLIA, LAUREN NICOLE (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:NICOLE
Last Name:TAGLIA
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:636 RAYMOND DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-9791
Mailing Address - Country:US
Mailing Address - Phone:630-315-6500
Mailing Address - Fax:630-778-6088
Practice Address - Street 1:636 RAYMOND DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-9791
Practice Address - Country:US
Practice Address - Phone:630-315-6500
Practice Address - Fax:630-778-6088
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.137145207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036137145Medicaid